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General NPI Number Information
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NPI Number | 1144199688
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Entity Type | Organization
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Legal Business Name | GIFT OF GRACE RESIDENCE
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 126 W 46TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90037-2722
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Country | US
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Telephone | 323-400-9462
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Fax |
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Provider Business Mailing Address
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Address Line | 611 WILSHIRE BLVD STE 900
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City | LOS ANGELES
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State | CA
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Zip | 90017-2905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KENISHA FANIEL
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Credential |
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Telephone | 323-400-9462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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